CAJ | 학술논문

目的探讨乳腺癌新辅助化疗后,临床疗效评价与病理评价之间存在差异的病理学基础.方法收集中国医学科学院肿瘤医院2005年6月至2007年12月施行乳腺癌新辅助化疗的209例.新辅助化疗前均行核芯针穿刺活检.化疗结束后4周内实施乳腺癌根治术.新辅助化疗前后均对乳腺原发灶进行临床体检、乳腺X线检查和(或)超声检查.实施新辅助化疗后,依实体瘤的疗效评价标准(RECIST,1.1版)对乳腺癌原发灶进行临床疗效评价,依Miller和Payne(MP)分级系统进行病理评价.应用SPSS 15.0软件分析临床评价与病理评价的相关性.结果 (1)新辅助化疗后依临床体检结果进行临床评价:完全缓解33例,部分缓解124例,疾病稳定41例,疾病进展11例.(2)新辅助化疗前后均行乳腺X线检查87例,依乳腺X线检查进行临床评价:完全缓解8例,部分缓解42例,疾病稳定37例.(3)新辅助化疗后MP分级病理评价:1级14例,2级35例,3级106例,4级36例,5级18例.(4)临床体检相关的临床评价与病理评价存在统计学相关性(x2=33.668,P=0.001),乳腺X线检查相关的临床评价与病理评价存在统计学相关性(x2=22.404,P=0.004).(5)新辅助化疗病理评价与X线检查相关临床评价存在差异的病理学改变有:残存浸润癌以脉管瘤栓为主要表现形式;伴有大片黏液湖形成的黏液腺癌;导管内癌残存,伴明显沙砾样钙化及周围组织的沙砾样钙化;间质结节状纤维化等.结论乳腺癌新辅助化疗的临床评价与病理评价存在统计学相关性.两者之间的差异有相应的病理学基础.伴有大片黏液湖形成的黏液腺癌、导管内癌的残存伴沙砾样钙化及间质结节状纤维化可能是临床评价低估治疗疗效的原因之一;而残存癌表现为脉管瘤栓可能是临床评价高估治疗疗效的原因之一.
목적 탐토유선암신보조화료후,림상료효평개여병리평개지간존재차이적병이학기출.방법 수집중국의학과학원종류의원2005년6월지2007년12월시행유선암신보조화료적209례.신보조화료전균행핵심침천자활검.화료결속후4주내실시유선암근치술.신보조화료전후균대유선원발조진행림상체검、유선X선검사화(혹)초성검사.실시신보조화료후,의실체류적료효평개표준(RECIST,1.1판)대유선암원발조진행림상료효평개,의Miller화Payne(MP)분급계통진행병리평개.응용SPSS 15.0연건분석림상평개여병리평개적상관성.결과 (1)신보조화료후의림상체검결과진행림상평개:완전완해33례,부분완해124례,질병은정41례,질병진전11례.(2)신보조화료전후균행유선X선검사87례,의유선X선검사진행림상평개:완전완해8례,부분완해42례,질병은정37례.(3)신보조화료후MP분급병리평개:1급14례,2급35례,3급106례,4급36례,5급18례.(4)림상체검상관적림상평개여병리평개존재통계학상관성(x2=33.668,P=0.001),유선X선검사상관적림상평개여병리평개존재통계학상관성(x2=22.404,P=0.004).(5)신보조화료병리평개여X선검사상관림상평개존재차이적병이학개변유:잔존침윤암이맥관류전위주요표현형식;반유대편점액호형성적점액선암;도관내암잔존,반명현사력양개화급주위조직적사력양개화;간질결절상섬유화등.결론 유선암신보조화료적림상평개여병리평개존재통계학상관성.량자지간적차이유상응적병이학기출.반유대편점액호형성적점액선암、도관내암적잔존반사력양개화급간질결절상섬유화가능시림상평개저고치료료효적원인지일;이잔존암표현위맥관류전가능시림상평개고고치료료효적원인지일.
Objective To investigate the pathologic basis of the difference between clinical response and pathologic response of breast carcinoma after neoadjuvant chemotherapy. Methods Two hundred and nine cases of breast cancer with neoadjuvant therapy were analyzed and clinical data were collected from June, 2005 to December, 2007. All patients had core needle biopsy taken before neoadjuvant chemotherapy and were operated within 4 weeks after neoadjuvant chemotherapy. Clinical examination, X-ray of breast and/or B ultrasonography of primary breast focus were taken before and after neoadjuvant chemotherapy. Clinical responses of breast primary focus were evaluated according to RECIST (response evaluation criteria in solid tumors) version 1.1. Pathologic responses of breast primary focus were evaluated according to Miller and Payne (MP) grading system. SPSS 15.0 software was used to statistical analysis. Results (1)Clinical responses basing on clinical examination showed complete response, partial response, stable disease and progressive response, in 33, 124, 41 and 11 cases respectively. (2) Eighty-seven cases had X-ray of breast taken before and after neoadjuvant chemotherapy. Clinical response basing on X-ray, showed complete response, partial response and stable disease in 8, 42 and 37 cases respectively. (3) Pathologic responses of breast primary focus were as MP1 (14 cases), MP2 (35 cases), MP3 (106 cases), MP4 (36 cases) and MP5 (18 cases). (4) The clinical response basing on clinical examination were related to the pathologic response (x2 = 33.668, P = 0.001); and the clinical response basing on X-ray of breast were also related to the pathologic response (x2 = 22.404, P = 0.004). (5) The pathologic basis of the difference between the pathologic response and the clinical response basing on X-ray of breast were: embolism of carcinoma, mucinons carcinoma, intraductal carcinoma with ossifying-type calcification, nodular fibrosis and others. Conclusions The clinical response may be related to the pathologic response. The difference between the two may be caused by pathologic changes. Some benign and malignant pathologic changes may contribute to the under-estimation of clinical response over pathologic response; whereas embolism of carcinoma may contribute to the over-estimation of clinical response over pathologic response.